Responding to People with Mental Illnesses at the Pretrial Stage
M.D. Fred Osher,
Council of State Governments Jus<ce Center Virginia Bersch Laura & John Arnold Founda<on Behavioral Health Training Summit SCA Co-‐Occurring Disorders & JMHCP Mental Health Grantees August 5, 2015
Learning Objec<ves By the end of this session, you will be able to: • Understand the state of research on pretrial risk assessment and supervision • List seven “Essen<al Elements” for responding to people with mental illnesses at the pretrial stage • Discuss considera<ons in applying these elements
Case Study: NYC Jail P opula<on (2005-‐2012)
With total average popula9on declining (-‐12%) and the sub-‐popula9on with mental health diagnoses (M Group) increasing (+32%), a greater propor,on of the average daily jail popula9on has a mental health diagnosis. AVERAGE DAILY JAIL POPULATION (ADP) AND ADP WITH MENTAL HEALTH DIAGNOSIS 13,576 Total
10,257 76%
24%
Source:
7,557 63%
3,319 2005
11,948 Total
4,391 37%
M Group
The City of New York Department of Correc9on
Non-‐M Group
2012
Average Length of Stay Contributes to High MH Prevalence in Average Daily Popula<on
61
Non-‐M Group N = 37,283
M Group (Overall)
112
N = 10,213
Days
Source:
The City of New York Department of CorrecKon & New York City Department of Health and Mental Hygiene 2008 Department of CorrecKon Admission Cohort with Length of Stay > 3 Days (First 2008 Admission)
Pretrial Detainees Are Most of the Jail Popula<on and Have the Biggest Difference in ALOS Average Pretrial Length of Stay for M Group was 2X as long.
ALOS for Sentenced Admissions (Days) Pretrial 62%
ALOS for Pretrial Admissions (Days)
40 79
60
Sentenced 24%
81
State Prison Sentence 15%
M Group Non-‐M Group Source:
The City of New York Department of CorrecKon 2008 Department of CorrecKon Admission Cohort with Length of Stay > 3 Days (First 2008 Admission)
Significant Progress Na<onally on Pretrial Policy & Prac<ce Na<onal Pretrial Jus<ce Coali<on
• Research • Policy • Prac<ce • Communica<ons • Public Opinion • Public Awareness
Council of State Governments JusKce Center | 6
A Note on Vocabulary: “Risk” • Pretrial “risk” – Failure to appear – New criminal acKvity while on pretrial release – And someKmes the risk of new violence
The release decision • Who is the decision-‐maker? • What are the consKtuKonal, statutory, or other rules that shape: • Who the decision-‐maker may release? • What factors the decision-‐maker must consider? • Is it appropriate to consider the defendants mental status? • What informaKon does the decision-‐maker have? • Is there an opportunity for reconsideraKon? 8
Legal Considera<ons Who should be detained pretrial? Who should be released? How should the judicial officer decide? U.S. Cons<tu<onal Law “The right to release before trial is condiKoned upon the accused's giving adequate assurance that he will stand trial and submit to sentence if found guilty. . . "[b]ail set at a figure higher than an amount reasonably calculated [to ensure the defendant's presence at trial] is 'excessive' under the Eighth Amendment." -‐ Stack v. Boyle (1951) “In our society, liberty is the norm, and detenKon prior to trial or without trial is the carefully limited excepKon.” -‐U.S. v. Salerno (1987) State Cons<tu<onal Law State Statutes Local Court Rules & Processes
Pretrial Risk Assessment Tools • • • • • • •
Federal Pretrial Risk Assessment Instrument (PTRA) Kentucky Pretrial Services Agency risk assessment (KPRA) Ohio Risk Assessment System-‐ Pretrial (ORAS-‐PAT) Virginia Pretrial Risk Assessment Instrument (VPRAI) Colorado Pretrial Assessment Tool (CPAT) “Arnold Tool”-‐ Public Safety Assessment Tool Locally developed tool
10
Research: What do we know about what happens pretrial?
Welcome to Virginia Bersch, Laura & John Arnold Founda9on
Council of State Governments JusKce Center | 11
Introduc<on to “Essen<al Elements” Document what good policy/prac<ce look like in a way that will be applicable across diverse jurisdic<ons in order to Inspire good policy/pracKce in a priority area
Improving Responses to People with Mental Illnesses • Specialized Law Enforcement-‐Based Response Programs • Mental Health Courts • Specialized ProbaKon IniKaKves
Responding to People with Mental Illnesses at the Pretrial Stage Prevalence of Serious Mental Illnesses & Co-‐Occurring Substance Use Disorders Jail Popula<on
83% 28%
17% 72%
Serious Mental Illness
Co-‐Occurring Substance Use Disorder
No Serious Mental Illness
No Co-‐Occurring Substance Use Disorder 13
Responding to People with Mental Illnesses at the Pretrial Stage Arrest Release Decision Condi<ons of Pretrial Release Pretrial Release • Supervision • Treatment
Diversion Reconsidera<on of Release Decision OR Modifica<on of Condi<ons
AdjudicaKon: Plea, Verdict, Charges Dropped
Diversion/ Alterna<ve to Deten<on • Supervision • Treatment
The Essen<al Elements 1 Collaborate 2 Training 3 Pretrial Release and Diversion Op<on 4 Informed Decision Making 5 Quick and Appropriate Behavioral Health and Support Services
6 Community Supervision and Treatment 7 Performance Measurement and Evalua<on
Responding to People with Behavioral Health Needs at the Pretrial Stage
FY 14 SCA COD Grantees
• Montgomery County, MD • Cumberland County, MA • Douglas County, NE • Rockdale County, GA • Jefferson County Commission, AL 16
The Essen<al Elements
1 Collaborate Criminal jus9ce and behavioral health leaders, managers, and line staff ac9vely work together to develop, operate, maintain, monitor, and improve responses to people with mental illnesses in the pretrial period.
Pretrial cons<tuencies • • • • • • • • • • • • •
Courts Prosecutors Defenders Defendants VicKms Pretrial Services Agencies Jail Community CorrecKons Community-‐based treatment Legislature Law enforcement County management Commercial bail bond industry/agents
18
The EssenKal Elements
1 Collaborate • Who needs to be at your table? • Establishing core principles • Roles for different agencies and levels of leadership in: • Planning • Opera9on • Sustainability
The EssenKal Elements
2 Training Criminal jus9ce and behavioral health stakeholders are familiar with legal and evidence-‐based prac9ces for pretrial release, supervision, and diversion, basic concepts in both pretrial jus9ce and behavioral health, and specific skills relevant to their professions.
The EssenKal Elements
2 Training • Legal and Evidence-‐Based Prac9ces • Cross-‐systems understanding • Skills for different professions
The EssenKal Elements
3 Pretrial Release and Diversion Op<ons Stakeholders use a range of mechanisms for quick and appropriate pretrial release and diversion.
The EssenKal Elements
3 Pretrial Release and Diversion Op<ons • What decision points do you see impac9ng? • Who will help defendants navigate these op9ons? Defense counsel? Judges? • How will you balance collec9ng informa9on with minimizing deten9on 9me?
The EssenKal Elements
4 Informed Decision-‐Making Judicial officers receive informa9on that is shown to be relevant to defendants’ probability of success on release to inform their decisions about release and to set the least restric9ve condi9ons to assure appearance in court and protect the public. Prosecutors use similar informa9on to inform decisions about diversion offers.
The EssenKal Elements
4 Informed Decision-‐Making • Are you using pretrial risk tools now? • How does this informa9on get to the judge? • If not, what would it take to do so? • How would you share informa9on so that the case is not unfairly impacted? • What sorts of condi9ons of release are in use?
The EssenKal Elements
5 Quick Connec<on to Appropriate
Behavioral Health Services and Supports Mental health, substance use, and other needs are iden9fied through screening and shared narrowly to direct defendants to appropriate treatment and services.
The EssenKal Elements
5 Quick Connec<on to Appropriate
Behavioral Health Services and Supports • What mental health and substance use needs informa9on are you collec9ng now that could help with connec9ons for pretrial release and diversion? • What sort of supports will be most important for this popula9on? • How will you decide who gets what in terms of treatment and supports?
The EssenKal Elements
6 Community Supervision and Treatment Criminal jus9ce and behavioral health stakeholders work together to support defendants’ adherence to condi9ons of release and, their progress towards recovery, and to minimize future jus9ce system involvement.
The EssenKal Elements
6 Community Supervision and Treatment • What supervision strategies are appropriate and realis9c pretrial? • How will treatment providers and pretrial services officers coordinate? • How will they respond to non-‐compliance with condi9ons of release? • Is there a way to move someone from pretrial release to diversion if they are doing well in community-‐based treatment and supervision?
The EssenKal Elements
7 Performance Measurement and
Evalua<on Data are collected and analyzed at regular intervals to iden9fy opportuni9es for improvement, assess quality in the delivery of treatment and supervision, and support ini9a9ve sustainability.
The EssenKal Elements
7 Performance Measurement and
Evalua<on • What does “success” for pretrial release look like? • What does “success” for pretrial diversion look like? • What can programs do to prepare for adverse events? • How will you incorporate quality assurance and improvement into your programs?
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The presentation was developed by members of the Council of State Governments Justice Center staff. The statements made reflect the views of the authors, and should not be considered the official position of the Justice Center, the members of the Council of State Governments, or the funding agency supporting the work. Citations available for statistics presented in preceding slides available on CSG Justice Center web site.